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Real-World Biologic Use Patterns in Severe Asthma, 2015-2021: The CLEAR Study
Trung N Tran1, Stephanie Chen1, Benjamin Emmanuel1
1Respiratory and Immunology, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA.
Pragmatic and Observational Research
|March 24, 2025
Summary
Switching or stopping biologic therapy for severe asthma is linked to worse outcomes. Continuing initial biologic treatment is associated with better clinical results and fewer exacerbations compared to changing or halting therapy.
Area of Science:
- Pulmonology
- Immunology
- Pharmacology
Background:
- Biologics targeting immunoglobulin E, interleukin (IL)-4/IL-13, or IL-5 pathways are used for severe asthma.
- Suboptimal patient responses can lead to treatment modifications, necessitating real-world data analysis.
Purpose of the Study:
- To assess real-world patterns of biologic use in severe asthma patients.
- To evaluate the clinical outcomes associated with continuing, switching, or stopping biologic therapy.
Main Methods:
- A multicenter, observational study (CLEAR) involving 1,859 adults from 23 countries in the International Severe Asthma Registry.
- Patients were categorized based on their biologic treatment trajectory (continue, switch, stop) within 6 months of initiation.
- Outcomes were assessed at 12 months using propensity score-weighted multivariable regression models.
Main Results:
- 60.0% continued, 25.5% switched, and 14.5% stopped biologic therapy.
- Switching or stopping was associated with higher annualized asthma exacerbation rates and uncontrolled asthma.
- Patients who switched experienced increased oral corticosteroid use, hospitalizations, and emergency room visits compared to those who continued therapy.
Conclusions:
- Switching or discontinuing biologic therapy in severe asthma is linked to poorer clinical outcomes.
- Continuing initial biologic treatment appears to be associated with more favorable long-term results.
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